Coding for Pediatric

Preventive Care, 2018

 Coding for Pediatric
Preventive Care, 2018
This resource contains comprehensive listings of codes
that may not be used by your practice on a regular
basis. We recommend that you identify the codes most
relevant to your practice and include those on your
encounter form or billing sheet.
Following are the Current Procedural Terminology
(CPT ®), Healthcare Common Procedure Coding System
(HCPCS) Level II, and International Classification of
Diseases, 10th Revision, Clinical Modification (ICD-10-
CM) codes most commonly reported by pediatricians
in providing preventive care services. The pediatrician,
not the staff, is ultimately responsible for the appropriate
codes to report.
Symbol Description
• A bullet at the beginning of a code means it is a new code
for the current year.
+ A plus sign means the code is an add-on code.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

© 2018 American Academy of Pediatrics

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means—electronic, mechanical, photocopying, recording, or otherwise — without prior written
permission from the publisher.

Printed in the United States of America

Current Procedural Terminology (CPT ®) 5-digit codes, nomenclature, and other data are copyright 2017
American Medical Association (AMA). All rights reserved. No fee schedules, basic units, relative values, or
related listings are included in CPT. The AMA assumes no liability for the data contained herein.

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The Bright Futures/American Academy of Pediatrics (AAP)
Recommendations for Preventive Pediatric Health Care, also
known as the “Periodicity Schedule,” is a schedule of screenings
and assessments recommended at each well-child visit from
infancy through adolescence. The following services and codes
coincide with this schedule. For more details on the Periodicity
Schedule see www.aap.org/periodicityschedule.

Preventive Medicine Service Codes

❖❖ Services included under these codes include measurements
(length/height, head circumference, weight, BMI, Blood
Pressure), age and gender appropriate exam and history
(initial or interval).
❖❖ To report the appropriate preventive medicine service code,
first determine if the patient qualifies as new or established
(defined in the next 2 sections), and then select the
appropriate code within the new or established code family
according to patient age.
❖❖ Preventive medicine service codes are not time-based;
therefore, time spent during the visit is not relevant in
selecting the appropriate preventive medicine services code.
❖❖ If an illness or abnormality is encountered, or a preexisting
problem is addressed, in the process of performing the
preventive medicine service, and if the illness, abnormality,
or problem is significant enough to require additional work
to perform the key components of a problem-oriented
evaluation and management (E/M) service (history, physical
examination, medical decision-making, or a combination
of those), the appropriate office or other outpatient service
code (99201–99215) should be reported in addition to the

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 preventive medicine service code. Modifier 25 should be
appended to the office or other outpatient service code to
indicate that a significant, separately identifiable E/M service
was provided by the same physician on the same day as the
preventive medicine service.
❖❖ An insignificant or trivial illness, abnormality, or problem
encountered in the process of performing the preventive
medicine service that does not require additional work and
performance of the key components of a problem-oriented
E/M service should not be reported.
❖❖ The comprehensive nature of the preventive medicine
service codes reflects an age- and gender-appropriate history
and physical examination and is not synonymous with the
comprehensive examination required for some other E/M
codes (eg, 99204, 99205, 99215).
❖❖ Immunizations and ancillary studies involving laboratory,
radiology, or other procedures, or screening tests (eg, vision,
developmental, and hearing screening) identified with
a specific CPT ® code, are reported separately from the
preventive medicine service code.

PREVENTIVE MEDICINE SERVICES:

NEW PATIENTS
❖❖ Initial comprehensive preventive medicine E/M of an
individual includes an age- and gender-appropriate history;
physical examination; counseling, anticipatory guidance,
or risk factor reduction interventions; and the ordering of
laboratory or diagnostic procedures.
❖❖ A new patient is defined as one who has not received any
professional face-to-face services rendered by physicians

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 and other qualified health care professionals who may
report E/M services and reported by a specific CPT ® code(s)
from a physician/other qualified health care professional, or
another physician/other qualified health care professional of
the exact same specialty and subspecialty who belongs to
the same group practice, within the past 3 years.

CPT ® Codes ICD-10-CM Codes

99381 Infant (younger than 1 year) Z00.110 Health supervision for newborn under
8 days old or
Z00.111 Health supervision for newborn 8 to
28 days old or
Z00.121 Routine child health exam with
abnormal findings
or
Z00.129 Routine child health exam without
abnormal findings

99382 Early childhood (age 1–4 years) Z00.121

Z00.129
99383 Late childhood (age 5–11 years)
99384 Adolescent (age 12–17 years)

99385 18 years or older Z00.00 General adult medical exam without

abnormal findings
Z00.01 General adult medical exam with
abnormal findings

PREVENTIVE MEDICINE SERVICES:

ESTABLISHED PATIENTS
Periodic comprehensive preventive medicine reevaluation
and management of an individual includes an age- and
gender-appropriate history; physical examination; counseling,
anticipatory guidance, or risk factor reduction interventions; and
the ordering of laboratory or diagnostic procedures.

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CPT ® Codes ICD-10-CM Codes
99391 Infant (younger than 1 year) Z00.110 Health supervision for newborn under
8 days old or
Z00.111 Health supervision for newborn 8 to
28 days old or
Z00.121 Routine child health exam with
abnormal findings
or
Z00.129 Routine child health exam without
abnormal findings

99392 Early childhood (age 1–4 years) Z00.121

Z00.129
99393 Late childhood (age 5–11 years)
99394 Adolescent (age 12–17 years)

99395 18 years or older Z00.00 General adult medical exam without

abnormal findings
Z00.01 General adult medical exam with
abnormal findings

Counseling, Risk Factor

Reduction, and Behavior Change
Intervention Codes
❖❖ Used to report services provided for the purpose of
promoting health and preventing illness or injury.
❖❖ They are distinct from other E/M services that may be
reported separately when performed. However, one
exception is you cannot report counseling codes (99401–
99404) in addition to preventive medicine service codes
(99381–99385 and 99391–99395).
❖❖ Counseling will vary with age and address such issues as
family dynamics, diet and exercise, sexual practices, injury
prevention, dental health, and diagnostic or laboratory test
results available at the time of the encounter.

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❖❖ Codes are time-based, where the appropriate code is
selected according to the approximate time spent providing
the service. Codes may be reported when the midpoint
for that time has passed. For example, once 8 minutes are
documented, one may report 99401.
❖❖ Extent of counseling or risk factor reduction intervention
must be documented in the patient chart to qualify the
service based on time.
❖❖ Counseling or interventions are used for persons without a
specific illness for which the counseling might otherwise be
used as part of treatment.
❖❖ Cannot be reported with patients who have symptoms or
established illness.
❖❖ For counseling individual patients with symptoms or
established illness, report an office or other outpatient
service code (99201–99215) instead.
❖❖ For counseling groups of patients with symptoms or
established illness, report 99078 (physician educational
services rendered to patients in a group setting) instead.

PREVENTIVE MEDICINE, COUNSELING

CPT ® Codes

99401 Preventive medicine counseling or risk factor

reduction intervention(s) provided to an individual;
approximately 15 minutes
99402 approximately 30 minutes
99403 approximately 45 minutes
99404 approximately 60 minutes

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CPT ® Codes

99411 Preventive medicine counseling or risk factor

reduction intervention(s) provided to individuals in a
group setting; approximately 30 minutes
99412 approximately 60 minutes

ICD-10-CM Codes for Preventive Counseling

❖❖ The diagnosis codes reported for preventive counseling will

vary depending on the reason for the encounter.
❖❖ Remember that the patient cannot have symptoms or
established illness; therefore, the diagnosis codes reported
cannot reflect symptoms or illnesses.
❖❖ Examples of some possible diagnosis codes include
Z28.3 Underimmunized status
Z71.3 Dietary surveillance and counseling
Z71.82 Exercise counseling
Z71.89 Other specified counseling
Z71.9 Counseling, unspecified

BEHAVIOR CHANGE INTERVENTIONS,

INDIVIDUAL
CPT ® Codes

❖❖ Used only when counseling a patient on smoking cessation

(99406–99407).
❖❖ If counseling a patient’s parent or guardian on smoking
cessation, do not report these codes (99406–99407)
under the patient; instead, refer to preventive medicine

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 counseling codes (99401–99404) if the patient is not
currently experiencing adverse effects (eg, illness), or include
under the problem-related E/M service (99201–99215).
❖❖ Codes (99406-99409) may be reported in addition to the
preventive medicine service codes.
99406 Smoking and tobacco use cessation counseling visit;
intermediate, greater than 3 minutes up to 10 minutes
99407 intensive, greater than 10 minutes
99408 Alcohol or substance (other than tobacco) abuse struc-
tured screening (eg, Alcohol Use Disorder Identification
Test [AUDIT], Drug Abuse Screening Test [DAST]) and
brief intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes

ICD-10-CM Codes for Risk Factor Reduction and

Behavior Change Interventions

F10.10 Alcohol abuse, uncomplicated

F11.10 Opioid abuse, uncomplicated
F12.10 Cannabis abuse, uncomplicated
F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.90 Sedative, hypnotic, or anxiolytic use, unspecified,
uncomplicated
F15.90 Other stimulant use, unspecified, uncomplicated
F16.90 Hallucinogen use, unspecified, uncomplicated
Z71.41 Alcohol abuse counseling and surveillance of alcoholic
Z71.42 Counseling for family member/partner/friend of alcoholic
Z71.51 Drug abuse counseling and surveillance of drug abuser
Z71.52 Counseling for family member/partner/friend of
drug abuser

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Z71.6 Tobacco abuse counseling
Z87.891 Personal history of nicotine dependence
Z91.89 Other specified personal risk factors, presenting as
hazards to health not elsewhere classified

Other Preventive Medicine Services

ORAL HEALTH
CPT ® Codes

99188 Application of topical fluoride varnish by a physician

or other qualified health care professional
Refer to page 17 for definition of other qualified health care
professional.
ICD-10-CM Codes

Z00.121 
Z00.129
Z29.3 Encounter for prophylactic fluoride administration
• Z91.841 Risk for dental caries, low
• Z91.842 Risk for dental caries, moderate
• Z91.843 Risk for dental caries, high
• Z91.849 Unspecified risk for dental caries

PELVIC EXAMINATION
❖❖ Preventive medicine service codes (99381–99385 and
99391–99395) include a pelvic examination as part of the
age- and gender-appropriate examination.

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❖❖ If the patient is having a problem, the physician can report
an office or other outpatient E/M service code (99212–
99215) for the visit and attach modifier 25, which identifies
that the problem-oriented pelvic visit is a separately
identifiable E/M service by the same physician on the same
date of service.
❖❖ Link the appropriate ICD-10-CM code for the well-child
or well-adult exam with abnormal findings (Z00.121 or
Z00.01) to the preventive medicine service code, but link
a different diagnosis code (eg, N89.8 [vaginal discharge],
N94.4 [primary dysmenorrhea]) to the office or other
outpatient E/M service code (eg, 99212).
❖❖ Anticipatory or periodic contraceptive management is not
a “problem” and is therefore included in the preventive
medicine service code; however, if contraception creates a
problem (eg, breakthrough bleeding, vomiting), the service
can be reported separately with an office or other outpatient
service code.
ICD-10-CM Codes

Z01.411 Gynecological exam with abnormal findings

Z01.419 Gynecological exam without abnormal findings
Z11.51 Screening for human papillomavirus (HPV)
Z12.72 Screening for malignant neoplasm of vagina
Z30.011 Initial prescription of contraceptive pills
Z30.012 Prescription of emergency contraception
Z30.013 Initial prescription of injectable contraceptive
Z30.014 Initial prescription of intrauterine contraceptive
device (IUD)

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Z30.015 Encounter for initial prescription of vaginal ring
hormonal contraceptive
Z30.016 Encounter for initial prescription of transdermal
patch hormonal contraceptive device
Z30.017 Encounter for initial prescription of implantable
subdermal contraceptive
Z30.018 Encounter for initial prescription of other
contraceptives
Z30.02 Counseling and instruction in natural family planning
to avoid pregnancy
Z30.09 General counseling and advice on contraception
Z30.40 Surveillance of contraceptives, unspecified
Z30.41 Surveillance of contraceptive pills
Z30.42 Surveillance of injectable contraceptive
Z30.430 Insertion of IUD
Z30.431 Routine checking of IUD
Z30.432 Removal of IUD
Z30.433 Removal and reinsertion of IUD
Z30.44 Encounter for surveillance of vaginal ring
hormonal contraceptive device
Z30.45 Encounter for surveillance of transdermal patch
hormonal contraceptive device
Z30.46 Encounter for surveillance of implantable
subdermal contraceptive
Z30.49 Surveillance of other contraceptives

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HEALTH RISK ASSESSMENTS
CPT ® Codes

96160 Administration of patient-focused health risk

assessment instrument (eg, health hazard
appraisal) with scoring and documentation, per
standardized instrument
96161 Administration of caregiver-focused health risk
assessment instrument (eg, depression
inventory) for the benefit of the patient, with
scoring and documentation, per standardized
instrument

NOTE: Code 96161 can be reported for a postpartum

screening administered to a mother as part of a routine
newborn check but billed under the baby’s name. Link to
ICD-10-CM code Z00.121 or Z00.129 for normal screening
results during a routine well-baby examination.

Used to report administration of standardized health risk

assessment instruments on the patient (96160) or a primary
caregiver (eg, parent) on behalf of the patient (96161). Code
96161 requires that the questions and answers relate to the
primary caregiver's health and behaviors, not the patient's.

UNLISTED PREVENTIVE MEDICINE SERVICE

CPT ® Code

99429 Unlisted preventive medicine service

Report code 99429 only when a more specific preventive
medicine service code does not exist.
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Screening Codes
VISION SCREENING
CPT ® Codes ICD-10-CM Codes
99173 Screening test of visual acuity Z00.121 Routine child health exam with
quantitative, bilateral abnormal findings
99174 Instrument-based ocular screening Z00.129 Routine child health exam without
(eg, photoscreening, automated- abnormal findings
refraction), bilateral, with remote-
analysis and report
99177 Instrument-based ocular screening
(eg, photoscreening, automated-
refraction), bilateral, with on-site
analysis

Z01.00 and Z01.01 (examination of eyes and vision with

and without abnormal findings) are reported only for routine
examination of eyes and vision, not when a vision screening is
done during a routine well-child examination.

❖❖ To report code 99173, you must employ graduate visual

acuity stimuli that allow a quantitative estimate of visual
acuity (eg, Snellen chart).
❖❖ Codes 99174 and 99177 are reported for instrument-based
ocular screening for esotropia, exotropia, anisometropia,
cataracts, ptosis, hyperopia, and myopia.
❖❖ Code 99177 is reported in lieu of 99174 when the screening
instrument provides you with immediate pass or fail results.
❖❖ When acuity (99173) or instrument-based ocular screening
(eg, 99174) is measured as part of a general ophthalmologic
service or an E/M service of the eye (eg, for an eye-related
problem or symptom), it is considered part of the diagnostic
examination of the office or other outpatient service code
(99201–99215) and is not reported separately.

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❖❖ Other identifiable services unrelated to the screening test
provided at the same time are reported separately (eg,
preventive medicine services).
❖❖ Failed vision screenings will most likely result in a follow-
up office visit (eg, 99212–99215). Report the follow-
up screening with Z01.00 if normal results or Z01.01 if
abnormal results. If abnormal, link to the diagnosis code
for the reason for the failure (eg, H52.1- [myopia]); when
a specific disorder cannot be identified, report R94.118
(abnormal results of other function studies of eye).

HEARING SCREENING
CPT ® Codes ICD-10-CM Codes
92551 Screening test, pure tone, air only Z00.121 Routine child health exam with
92552 Pure tone audiometry (threshold), abnormal findings
air only Z00.129 Routine child health exam without
92567 Tympanometry (impedance testing) abnormal findings

Codes Z01.10 (encounter for exam of ears and hearing without

abnormal findings) and Z01.118 (encounter for exam of ears and
hearing with other abnormal findings) are reported only when a
patient presents for an encounter specific to ears and hearing, not for
a routine well-child exam at which a hearing screening is performed.
❖❖ Requires use of calibrated electronic equipment; tests using
other methods (eg, whispered voice, tuning fork) are not
reported separately.
❖❖ Includes testing of both ears; append modifier 52 when a
test is applied to only one ear.
❖❖ Other identifiable services unrelated to the screening test
provided at the same time are reported separately (eg,
preventive medicine services).

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❖❖ Failed hearing screenings will most likely result in a follow-up
office visit (eg, 99212–99215). Code Z01.110 (encounter
for hearing exam following failed hearing screening) is
reported when a specific disorder cannot be identified or
when the follow-up hearing screening findings are normal.
You can also report Z01.118 (encounter for exam of ears
and hearing with other abnormal findings) and include the
code for the abnormal findings (eg, R94.120 [abnormal
auditory function study]).

DEVELOPMENTAL SCREENING AND

EMOTIONAL/BEHAVIORAL ASSESSMENT
CPT ® Codes ICD-10-CM Codes
96110 Developmental screening, per Z13.4- Encounter for screening for certain
instrument, scoring and developmental disorders in childhood
documentation (excludes developmental screening
96127 Brief emotional/behavioral during a routine well child exam)
assessment (eg, depression Z13.89 Encounter for screening for other
inventory) with scoring and disorder (eg, depression)
documentation, per standardized
instrument

❖❖ Used to report administration of standardized

developmental screening instruments (96110) or
behavioral/emotional assessments (96127).
❖❖ The ICD-10-CM code Z13.4- is not to be used for routine
developmental screening performed during a routine well-
child exam. The ICD-10-CM code Z13.89 is not necessary
to report in addition to a well-child exam.
❖❖ Often reported when performed in the context of preventive
medicine services but may also be reported when screening
or assessment is performed with other E/M services (eg,
acute illness or follow-up office visits).

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❖❖ Clinical staff (eg, registered nurse) typically administers
and scores the completed instrument, while the physician
incorporates the interpretation component into the
accompanying E/M service.
❖❖ When a standardized screening or assessment is administered
along with any E/M service (eg, preventive medicine
service), both services should be reported, and modifier 25
(significant, separately identifiable E/M service by the same
physician on the same day of the procedure or other service)
may need to be appended to the E/M code to show the E/M
service was distinct and necessary at the same visit.
❖❖ Examples of both 96110 and 96127 instruments can be
found online at https://www.aap.org/en-us/professional
-resources/practice-transformation/getting-paid/Coding
-at-the-AAP/Pages/Private/Developmental-Screening-and
-Testing.aspx.

Immunizations
IMMUNIZATION ADMINISTRATION
Pediatric Immunization Administration Codes

90460 Immunization administration (IA) through 18 years

of age via any route of administration, with
counseling by physician or other qualified health care
professional; first or only component of each vaccine
or toxoid administered
+90461 each additional vaccine or toxoid component
administered
Report 90461 in conjunction with 90460.

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❖❖ Component refers to all antigens in a vaccine that prevent
diseases caused by 1 organism. Multivalent antigens or multiple
serotypes of antigens against a single organism are considered
a single component of vaccines. Combination vaccines are
vaccines that contain multiple vaccine components. Conjugates
or adjuvants contained in vaccines are not considered to be
component parts of the vaccine, as defined previously.
❖❖ A qualified health care professional is an individual who by
education, training, licensure/regulation, facility credentialing
(when applicable), and payer policy is able to perform
a professional service within his or her scope of practice
and to independently report a professional service. These
professionals are distinct from clinical staff. A clinical staff
member is a person who works under the supervision of a
physician or other qualified health care professional and who is
allowed by law, regulation, facility, and payer policy to perform
or assist in the performance of specified professional services
but does not individually report any professional services.
❖❖ Code 90460 is used to report the first or only component in
a single vaccine given during an encounter. You can report
90460 more than once during a single office encounter.
Code 90461 is considered an add-on code to 90460
(hence the + symbol next to it). This means that the
provider will use 90461 in addition to 90460 if more
than 1 component is contained within a single vaccine
administered. The CPT ® codes 90460 and 90461 are
reported regardless of route of administration.
❖❖ Pediatric immunization administration (IA) codes (90460–
90461) are reported only when both of the following
requirements are met:

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 1. The patient must be 18 years or younger.
2. The physician or other qualified health care
professional must perform face-to-face vaccine
counseling associated with the administration.

NOTE: The clinical staff can do the actual

administration of the vaccine.

❖❖ If both of these requirements are not met, report a

non–age-specific IA code (90471–90474) instead.

Non–age-specific Immunization Administration Codes

❖❖ Report a CPT for both the administration and product and

®

an ICD-10-CM code for each vaccine administered during a

patient encounter.
90471 IA (includes percutaneous, intradermal, subcutaneous,
or intramuscular injections); one vaccine (single or
combination vaccine/toxoid)
Do not report 90471 in conjunction with 90473.
+90472 each additional vaccine (single or combination
vaccine/toxoid) (List separately to code for
primary procedure.)
Use 90472 in conjunction with 90460, 90471, or
90473.
90473 IA (includes intranasal or oral administration); one
vaccine (single or combination vaccine/toxoid)
Do not report 90473 in conjunction with 90471.
+90474 each additional vaccine (single or combination
vaccine/toxoid) (List separately to code for
primary procedure.)

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 Use 90474 in conjunction with 90460, 90471, or
90473.
❖❖ Codes 90471 and 90473 are used to code for the first
immunization given during a single office visit. Codes 90472
and 90474 are considered add-on codes (hence the + symbol
next to them) to 90460, 90471, and 90473. This means that
the provider will use 90472 or 90474 in addition to 90460,
90471, or 90473 if more than 1 vaccine is administered during
a visit. There can be only 1 first administration during a given
visit. (See vignettes 3, 4, and 5 on pages 23–26.)
❖❖ If during a single encounter for a patient 18 years or
younger, a physician or other qualified health care
professional only counsels on some of the vaccines, report
code 90460 (and 90461 when applicable) for those
counseled on and defer to codes 90472 or 90474, as
appropriate, for those that are not counseled on.
❖❖ The following vignettes may help illustrate the correct use of
the administration codes:

NOTE: The coding vignettes are for teaching purposes

and do not necessarily follow every payer’s reporting
requirements.

Vignette 1
A 5-year-old established patient is at a physician’s office for
her annual well-child examination. The patient is scheduled to
receive her first hepatitis A vaccine; her fifth diphtheria, tetanus,
and acellular pertussis (DTaP) vaccine; and the influenza
vaccine. After distributing the Vaccine Information Statements
and discussing the risks and benefits of immunizations with her
parents, the physician administers the vaccines.
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How are the appropriate codes for this service selected?
Step 1: Select appropriate E/M code.
99393 Preventive medicine service, established patient,
age 5 to 11 years

Step 2: Select appropriate vaccine product codes.

90633 Hepatitis A vaccine, pediatric/adolescent dosage
(2-dose schedule), for intramuscular use
90700 DTaP, for use in individuals younger than 7 years,
for intramuscular use
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus,
preservative free, 0.5 mL dosage, for IM use

Step 3: Select appropriate IA codes by considering the

following questions:
❖❖ Is the patient 18 years or younger?
❖❖ If the patient is younger than 18 years, did the physician or
other qualified health care professional perform the face-
to-face vaccine counseling, discussing the specific risks and
benefits of the vaccines?
If the answer to both questions is yes, select a code from the
pediatric IA code family (90460–90461). If the answer to one
of the questions is no, select a code from the non–age-specific
IA code family (90471–90474).
In this vignette, the answer to both questions is yes. Therefore,
the following IA codes will be reported:
90460 IA through 18 years of age via any route of
administration, with counseling by physician or
other qualified health care professional; first or only
component of each vaccine or toxoid administered

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+90461 each additional vaccine or toxoid component
administered (List separately in addition to code
for primary procedure.)
Step 4: Select the appropriate ICD-10-CM diagnosis
codes.
Diagnosis codes are used along with CPT ® codes to reflect the
outcome of a visit. The CPT codes tell a carrier what was done,
and ICD-10-CM codes tell a carrier why it was done.
The vaccine product CPT code and its corresponding IA
CPT code are always linked to the same ICD-10-CM code.
This is because the vaccine product and work that goes into
administering that product are intended to provide prophylactic
vaccination against a certain type of disease.
The ICD-10-CM lists only a single code to describe an encounter
in which a patient receives a vaccine. The code is Z23, and it
is reported at any encounter when a vaccine is given, including
routine well-child or adult exams.
The diagnosis codes for the 3 vaccines and 3 IA codes used in
this vignette are as follows:

CPT ® Codes ICD-10-CM Codes

99393 25 Preventive medicine service, established patient, 5–11 years Z00.129
90633 Hepatitis A vaccine product Z23
90460 Pediatric IA (hepatitis A vaccine), first component Z23
90700 DTaP vaccine product Z23
90460 Pediatric IA (DTaP vaccine), first component Z23
90461 (×2) Pediatric IA (DTaP vaccine), each additional component Z23
90686 Influenza virus vaccine, quadrivalent, preservative free, Z23
0.5 mL dosage
90460 Pediatric IA (influenza vaccine), first component Z23

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Alternative Coding
CPT ® Codes ICD-10-CM Codes
99393 25 Preventive medicine service, established patient, 5–11 years Z00.129
90633 Hepatitis A vaccine product Z23
90700 DTaP vaccine product Z23
90686 Influenza virus vaccine, quadrivalent, preservative free, Z23
0.5 mL dosage
90460 (×3) Pediatric IA (hepatitis A, DTaP, influenza vaccines), Z23
first component
90461 (×2) Pediatric IA (DTaP vaccine), second and third components Z23

NOTE: most payers do not want multiple line items of codes

90460 or 90461; therefore, follow the alternative coding.

Rationale
Because the patient is younger than 18 years and there is
physician counseling, pediatric IA codes are reported (90460
and 90461). Each vaccine administered will be reported with its
own 90460 (hepatitis A, DTaP, and influenza). The only vaccine
with multiple components is DTaP. Because the first component
(ie, diphtheria) was counted in 90460, only the second and
third components (tetanus and acellular pertussis) are reported
with 90461 with 2 units.

Vignette 2
A 2-month-old established patient presents for her checkup. The
following vaccines are ordered: DTaP-Haemophilus influenzae
type b-inactivated poliovirus (Pentacel), pneumococcal, and
rotavirus. The physician counsels the parents on all of them, and
the nurse administers them all.

22
 CPT ® Codes ICD-10-CM Codes
99391 25 Preventive medicine service, established patient, <1 year Z00.129
90698 DTaP-Hib-IPV (Pentacel) product Z23
90670 Pneumococcal product Z23
90680 Rotavirus vaccine, oral use Z23
90460 (×3) Pediatric IA (Pentacel, pneumococcal, rotavirus), first Z23
component
90461 (×4) Pediatric IA (Pentacel), each additional component Z23

Rationale
Because the patient is younger than 18 years and there is
physician counseling, pediatric IA codes are reported (90460,
90461). Clinical staff may administer the vaccine. Even though
an oral vaccine is administered, 90460 is still reported because
the code descriptor reads any route.

Vignette 3
A 19-year-old patient presents to the office to complete a
college physical examination (in college the patient will be living
in a dormitory). He is due for a tetanus-diphtheria-acellular
pertussis (Tdap) booster, meningococcal vaccine, and intranasal
influenza vaccine. The physician counsels the patient on each,
and the nurse administers each.

CPT ® Codes ICD-10-CM Codes

99395 25 Preventive medicine service, established patient, Z02.0
18–39 years
90715 Tdap product Z23
90471 IA, first injection Z23
90734 Meningococcal (MCV4) product Z23
90472 (×2) IA, each additional injection Z23
90686 Influenza virus vaccine, quadrivalent, preservative free, Z23
0.5 mL dosage

23
 Rationale
The patient is older than 18 years; therefore, despite physician
counseling, pediatric IA codes cannot be reported. Instead,
codes 90471–90474 must be used.

Vignette 4
A 17-year-old patient presents to the office for her annual
checkup and to complete a college physical examination (in
college the patient will be living in a dormitory). The patient is
healthy and due for a Tdap booster, meningococcal vaccine, first
human papillomavirus (HPV, 9-valent) vaccine, and influenza
vaccine. The physician counsels the patient only on the
meningococcal and HPV vaccines, and the nurse administers
each. The patient is asked to return in 4 to 6 weeks for her
second HPV vaccine.

CPT ® Codes ICD-10-CM Codes

(First Visit Only) (First Visit Only)
99394 25 Preventive medicine service, established patient, Z00.00 and Z02.0
12–17 years
90734 Meningococcal (MCV4) product Z23
90651 HPV (9-valent) product Z23
90460 (×2) Pediatric IA (meningococcal and HPV) first component Z23
90715 Tdap product Z23
90472 (×2) IA, each additional injection (Tdap) Z23
90686 Influenza virus vaccine, quadrivalent, preservative free, Z23
0.5 mL dosage

Rationale
Because the physician documents counseling only for the
meningococcal and HPV vaccines, code 90460 can be reported
only for those vaccines because the patient meets the age
criteria. For the Tdap and influenza vaccines, defer to non-
pediatric IA codes (90471–90472). In this case, however, a

24
first vaccine code is already reported with code 90460, so the
additional IA code 90472 has to be reported. While ICD-10-CM
does not provide official ages for the “adult” ICD-10-CM codes
(Z00.00 and Z00.01) in lieu of the well-child examination
codes, many payers use age 17 years as the cutoff. Refer to
specific payer policy for details.

Vignette 5
A 6-month-old patient presents to the office for her routine
checkup and to receive vaccines. The patient is due for DTaP,
pneumococcal, and hepatitis B vaccines. During the examination,
the physician finds an upper respiratory infection and fever.
The physician counsels the parent on the vaccines but decides
to defer for 2 weeks. The physician completes the well-baby
checkup on that day.
Two weeks later, the patient returns. The patient is afebrile
and asymptomatic and is seen only by the nurse. The DTaP,
pneumococcal, and hepatitis B vaccines are administered.

CPT ® Code ICD-10-CM Code

(First Visit) (First Visit)
99391 Preventive medicine service, established patient, <1 year Z00.121
An appropriate acute sick visit (eg, 99213) may be reported in addition with modifier 25 and
linked to an appropriate ICD-10-CM code.

CPT ® Codes ICD-10-CM Codes

(2 Weeks Later) (2 Weeks Later)
90700 DTaP product Z23
90670 Pneumococcal product Z23
90744 Hepatitis B vaccine product Z23
90471 IA (DTaP), first vaccine Z23
90472 (×2) IA (pneumococcal, hepatitis B), each additional vaccine Z23

25
Rationale
If counseling occurs outside the IA service, there is no way to
report it separately. Therefore, in this vignette, there is nothing
separate to report during the well-child visit, and when the
patient returns and sees only the nurse, pediatric IA codes
cannot be reported; defer to codes 90471–90474. During the
preventive medicine service, when an acute illness is detected,
a code from 99212–99215 can be reported if the service is
significant and separately identifiable. Code 9921x is reported
with modifier 25. When the patient returns only for vaccines,
an E/M service is not reported. The ICD-10-CM code will be
reported for with abnormal findings (Z00.121) because an
abnormality was identified during the encounter.
For more information on IA codes, refer to the Coding at the
AAP Web site (www.aap.org/coding) and its page dedicated to
vaccine coding.

HOW TO CODE WHEN IMMUNIZATIONS

ARE NOT ADMINISTERED
ICD-CM -10 Codes

❖❖ For many reasons, immunizations are not given during

routine preventive medicine services. Parents may refuse
vaccines or defer them, a patient may be ill at the time and
it is counteractive to administer, or the patient may already
have had the disease or be immune.
❖❖ Because of tracking purposes and quality measures, it is
important to report non-administration as part of the ICD-
10-CM codes. The following ICD-10-CM codes were created
to report why a vaccine is not given:

26
Vaccination not carried out due to
Z28.01 Acute illness
Z28.02 Chronic illness or condition
Z28.03 Immunocompromised state
Z28.04 Allergy to vaccine or component
Z28.1 Religious reasons
Z28.20 Unspecified reason
Z28.21 Patient refusal
Z28.81 Patient has disease being vaccinated against
Z28.82 Caregiver refusal
Z28.89 Other reason

Vignette
A 1-year-old presents for his routine well-child examination.
He is scheduled to receive his first measles, mumps, rubella;
hepatitis A; and varicella vaccines. Because he had a documented
case of varicella when he was 9 months of age, the varicella
vaccine is not given.
Report the following ICD-10-CM codes linked to the E/M service:
Z23 Encounter for immunization
Z28.81 Vaccination not carried out due to patient had disease
being vaccinated against

Vaccines for Children Program

The rules for reporting vaccines for patients who qualify for
the Vaccines for Children (VFC) program vary greatly. Some
states require that the product code be submitted, while others
require the IA codes. Some require the use of modifiers, while
others do not. Currently, the VFC program does not recognize
27
component-based vaccine counseling; therefore, you will not be
paid for CPT ® code 90461. The American Academy of Pediatrics
continues to work on changing this so pediatric providers can be
properly compensated for giving multiple-component vaccines.

Commonly Administered Pediatric Vaccines

No. of
Product Separately report the administration with codes Vaccine
Code 90460–90461 or 90471–90474. Manufacturer Brand Components

90702 Diphtheria and tetanus toxoids (DT), adsorbed when SP Diphtheria and 2
administered to younger than seven years, for IM use Tetanus Toxoids
Adsorbed
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine SP DAPTACEL 3
(DTaP), when administered to <7 years, for IM usea GSK INFANRIX
90696 Diphtheria, tetanus toxoids, and acellular pertussis vaccine GSK KINRIX 4
and inactivated poliovirus vaccine (DTaP-IPV), when SP Quadracel
administered to children 4-6 years of age, for IM use
90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, GSK PEDIARIX 5
Hepatitis B, and inactivated poliovirus vaccine
(DTaP-Hep B-IPV), for IM use
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, SP Pentacel 5
haemophilus influenza Type B, and inactivated poliovirus
vaccine (DTaP-IPV/Hib), for IM use
90633 Hepatitis A vaccine (Hep A), pediatric/adolescent dosage, GSK HAVRIX 1
2 dose, for IM use Merck VAQTA
90740 Hepatitis B vaccine (Hep B), dialysis or immunosuppressed Merck RECOMBIVAX HB 1
patient dosage, 3 dose, for IM use
90743 Hepatitis B vaccine (Hep B), adolescent, 2 dose, for IM use Merck RECOMBIVAX HB 1
90744 Hepatitis B vaccine (Hep B), pediatric/adolescent dosage, Merck RECOMBIVAX HB 1
3 dose, for IM use GSK ENERGIX-B
90746 Hepatitis B vaccine (Hep B), adult dosage, for IM use Merck RECOMBIVAX HB 1
GSK ENERGIX-B
90747 Hepatitis B vaccine (Hep B), dialysis or immunosuppressed GSK ENERGIX-B 1
patient dosage, 4 dose, for IM use
90748 Hepatitis B and Hib (Hep B-Hib), for IM use Merck COMVAX 2
90647 Hemophilus influenza B vaccine (Hib), PRP-OMP conjugate, Merck PedvaxHIB 1
3 dose, for IM use
90648 Hemophilus influenza B vaccine (Hib), PRP-T conjugate, SP ActHIB 1
4 dose, for IM use GSK HIBERIX
90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, Merck GARDASIL 9 1
52, 58, nonavalent (HPV), 2 or 3 dose schedule, for IM use
90630 Influenza virus vaccine, quad (IIV4), split virus, preservative SP Fluzone 1
free, for intradermal use Intradermal Quad
90672 Influenza virus vaccine, quad (LAIV), live, intranasal use MedImmune Flumist Quad 1
90674 Influenza virus vaccine, quad (ccIIV4), derived from cell Seqirus Flucelvax 1
cultures, subunit, preservative and antibiotic free, 0.5 mL
dosage, IM (Do not use for multi-dose – report 90749)
(continued on next page)

28
(continued from previous page)

No. of
Product Separately report the administration with codes Vaccine
Code 90460–90461 or 90471–90474. Manufacturer Brand Components

90682 Influenza virus vaccine, quad (RIV4), derived from Protein Flublok 1
recombinant DNA, HA protein only, preservative and antibiotic Sciences
free, IM use
90685 Influenza virus vaccine, quad (IIV4), split virus, preservative SP Fluzone Quad 1
free, 0.25ml dose, for IM use
90686 Influenza virus vaccine, quad (IIV4), split virus, preservative Seqirus Afluria 1
free, 0.5ml dosage, for IM use SP FLUARIX Quad
GSK Fluzone Quad
GSK FLULAVAL
90687 Influenza virus vaccine, quad (IIV4), split virus, 0.25ml dosage, SP Fluzone Quad 1
for IM use
90688 Influenza virus vaccine, quad (IIV4), split virus, 0.5ml dosage, SP Fluzone Quad 1
for IM use GSK FLULAVAL
90756 or Influenza virus vaccine, quad(ccIIV4), derived from cell cultures, Seqirus Flucelvax Quad 1
90749 subunit, antibiotic free, 0.5mL dosage, for IM use
90656 Influenza virus vaccine, tri (IIV3), split virus, preservative Seqirus AFLURIA 1
free, 0.5ml dosage, for IM use Novatis Fluvirin
90658 Influenza virus vaccine, tri (IIV3), split virus, 0.5ml dosage, for Seqirus AFLURIA 1
IM use Novartis Fluvirin
90673 Influenza virus vaccine, tri (RIV3), derived from recombinant Protein Flublok 1
DNA, HA protein only, preservative and antibiotic free, IM use Sciences
90707 Measles, mumps, and rubella virus vaccine (MMR), live, for Merck M-M-R II 3
subcutaneous use
90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, Merck ProQuad 4
for subcutaneous use
90620 Meningococcal recombinant protein and outer membrane Novartis Bexsero 1
vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule,
for IM use
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, Pfizer Trumenba 1
2 or 3 dose schedule, for IM use
90644 Meningococcal conjugate vaccine, serogroups C & Y and GSK MenHibrix 2
Hemophilus influenza B vaccine (MenCY-Hib), 4-dose
schedule, (children 6 weeks-18 months of age), for IM use
90733 Meningococcal polysaccharide vaccine, serogroups A, C, Y, SP Menomune 1
W-135, quad (MenACWY or MPSV4), for subcutaneous use
90734 Meningococcal conjugate vaccine, serogroups A, C, Y and SP Menactra 1
W-135 quad (MenACWY or MCV4) , for IM use Novartis Menveo
90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for IM use Pfizer PREVNAR 13
90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), Merck PNEUMOVAX 23 1
adult or immunosuppressed patient dosage, when
administered to 2 years or older, for subcutaneous or IM use
90713 Poliovirus vaccine (IPV), inactivated, for subcutaneous or SP IPOL 1
IMuse
90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, Merck RotaTeq 1
for oral use
(continued on next page)

29
(continued from previous page)

No. of
Product Separately report the administration with codes Vaccine
Code 90460–90461 or 90471–90474. Manufacturer Brand Components

90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose GSK ROTARIX 1

schedule, live, for oral use
90714 Tetanus and diphtheria toxoids (Td) adsorbed, preservative MBL Td (adult) adsorbed 2
free, when administered to seven years or older, for IM use SP TENIVAC

90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine SP ADACEL 3
(Tdap), when administered to 7 years or older, for IM use GSK BOOSTRIX

90716 Varicella virus vaccine (VAR), live, for subcutaneous use Merck VARIVAX 1
90749 Unlisted vaccine or toxoid Please See CPT Manual
Developed and maintained by the American Academy of Pediatrics. Updated periodically at https://www.aap.org/en-us/
Documents/coding_vaccine_coding_table.pdf. For reporting purposes only.

Laboratory
Two different practice models surround the conducting of
laboratory tests: blood is drawn in office and specimen is sent
to an outside laboratory for analysis, or blood is drawn and
laboratory tests are performed in the physician’s practice. Never
report the laboratory code for a laboratory test that the practice
does not run in-house or is not financially responsible for and
billed by the outside laboratory. In those cases, report only the
blood draw and specimen handling, as appropriate.

30
MODEL 1: BLOOD IS DRAWN IN OFFICE
AND SPECIMEN IS SENT TO AN OUTSIDE
LABORATORY FOR ANALYSIS.
CPT ® Code

99000 Handling and/or conveyance of specimen for transfer

from the physician’s office to a laboratory
Venipuncture CPT ® Codes

36406 Venipuncture, younger than 3 years, necessitating

physician’s skill, not to be used for routine venipuncture
36410 Venipuncture, 3 years or older, necessitating
physician’s skill, for diagnostic or therapeutic purposes
(not be used for routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger,
heel, ear stick)
Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for

specific screening tests.

MODEL 2: BLOOD IS DRAWN AND

LABORATORY TESTS ARE PERFORMED IN
THE PHYSICIAN’S PRACTICE.
Venipuncture CPT ® Codes

36406 Venipuncture, younger than 3 years, necessitating

physician’s skill, not to be used for routine venipuncture

31
36410 Venipuncture, 3 years or older, necessitating
physician’s skill, for diagnostic or therapeutic purposes
(not be used for routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger,
heel, ear stick)
Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for

specific screening tests.
Bilirubin CPT ® Codes

82247 Bilirubin, total

88720 Bilirubin, total, transcutaneous
Bilirubin ICD-10-CM Code

Z13.228 Encounter for screening for other metabolic disorder

Dyslipidemia Screening CPT ® Codes

80061 Lipid panel (includes total cholesterol, high-density

lipoprotein [HDL] cholesterol, and triglycerides)
82465 Cholesterol, serum, total
83718 Lipoprotein, direct measurement, high-density
cholesterol (HDL cholesterol)
84478 Triglycerides
Dyslipidemia Screening ICD-10-CM Code

Z13.220 Encounter for screening for lipid disorders

Anemia Screening CPT ® Code

85018 Blood count; hemoglobin

32
Anemia Screening ICD-10-CM Code

Z13.0 Encounter for screening for diseases of the blood and

blood-forming organs and certain disorders involving
the immune mechanism (eg, anemia)
Lead Screening CPT ® Code

83655 Lead
Lead Screening ICD-10-CM Code

Z13.88 Encounter for screening for disorder due to exposure

to contaminants
Newborn Metabolic Screening HCPCS Code

NOTE: See Healthcare Common Procedure Coding System

Codes section on page 36 for explanation of HCPCS codes.

S3620 Newborn metabolic screening panel, includes test

kit, postage, and the laboratory tests specified by
the state for inclusion in this panel (eg, galactose;
hemoglobin, electrophoresis; hydroxyprogesterone,
17-D; phenylalanine [phenylketonuria (PKU)]; and
thyroxine, total)

NOTE: Only report the S3620 if you are billing for the actual
running of the lab or test kit. Otherwise only report the
appropriate blood collection code (eg, 36416)

Newborn Metabolic Screening ICD-10-CM Codes

Report the diagnosis codes for the state-specific newborn

screening tests conducted. Examples include

33
Z13.0 Encounter for screening for diseases of the blood and
blood-forming organs and certain disorders involving
the immune mechanism (eg, anemia, sickle cell)
Z13.21 Encounter for screening for nutritional disorder
Z13.228 Encounter for screening for other metabolic disorders
(eg, PKU, galactosemia)
Z13.29 Encounter for screening for other suspected
endocrine disorder (eg, thyroid)

Papanicolaou Smear HCPCS Code

NOTE: See Healthcare Common Procedure Coding System

Codes on page 36 for explanation of HCPCS codes.

Q0091 Screening Papanicolaou smear; obtaining, preparing, and

conveyance of cervical or vaginal smear to laboratory

Papanicolaou Smear CPT ® Code

Collection of a cervical specimen via a pelvic examination is

included in the preventive medicine service code (99381–
99385 and 99391–99395).

Papanicolaou Smear ICD-10-CM Codes

Z12.4 Encounter for screening for malignant neoplasm of

cervix (excludes HPV)
Z12.72 Encounter for screening for malignant neoplasm of
vagina
Z12.79 Encounter for screening for malignant neoplasm of
other genitourinary organs

34
Z12.89 Encounter for screening for malignant neoplasms of
other sites
Tuberculosis Testing (Mantoux/Purified Protein
Derivative [PPD])

Administration of PPD Test

CPT ® Code ICD-10-CM Code
86580 Skin test; tuberculosis, intradermal Z11.1 Encounter for screening for respiratory
tuberculosis

NOTE: There is no separate administration code for the PPD

test. Do not report one.

Reading of PPD Test

If patient returns to have a nurse read the test results, report
CPT ® Code ICD-10-CM Codes
99211 Office or other outpatient services Z11.1 Encounter for screening for respiratory
(nurse visit or negative outcome) tuberculosis (if test is negative)
99212-
Office or outpatient services R76.11 Nonspecific reaction to tuberculin skin
99215 (physician service for positive
tuberculosis (if test is positive)

encounter)

Sexually Transmitted Infection and HIV Screening

CPT ® Codes

86701 Antibody; HIV-1

86703 Antibody; HIV-1 and HIV-2; single assay
87490 Infectious agent detection by nucleic acid (DNA or
RNA); Chlamydia trachomatis, direct probe technique
87491 Infectious agent detection by nucleic acid (DNA or RNA);
C trachomatis, amplified probe technique
87590 Infectious agent detection by nucleic acid (DNA or
RNA); Neisseria gonorrhoeae, direct probe technique

35
87591 Infectious agent detection by nucleic acid (DNA or
RNA); N gonorrhoeae, amplified probe technique
87810 Infectious agent detection by immunoassay with
direct optical observation; C trachomatis
87850 Infectious agent detection by immunoassay with
direct optical observation; N gonorrhoeae

Sexually Transmitted Infection and HIV Screening

ICD-10-CM Codes

Z11.3 Encounter for screening for infections with a

predominantly sexual mode of transmission (excludes
HPV and HIV)
Z11.8 Encounter for screening for other infectious and
parasitic diseases (eg, chlamydia)

Healthcare Common Procedure

Coding System Codes
❖❖ The HCPCS Level II codes are procedure codes used to report
services and supplies not included in the CPT ® nomenclature.
❖❖ Like CPT ®
codes, HCPCS Level II codes are part of the
standard procedure code set under the Health Insurance
Portability and Accountability Act of 1996.
❖❖ Certain payers may require that HCPCS codes be reported
in lieu of or as a supplement to CPT codes.
❖❖ The HCPCS nomenclature contains many codes for reporting
nonphysician provider patient education, which can be an
integral service in the provision of pediatric preventive care.

36
❖❖ Examples of HCPCS Level II codes relevant to pediatric
preventive care include
S0302 Completed Early and Periodic Screening, Diagnosis,
and Treatment service (List in addition to code for
appropriate E/M service.)
S0610 Annual gynecologic examination; new patient
S0612 Annual gynecologic examination; established patient
S0613 Annual gynecologic examination, clinical breast
examination without pelvic examination
S0622 Routine examination for college, new or established
patient (List separately in addition to appropriate
E/M code.)
S9444 Parenting classes, nonphysician provider, per session
S9445 Patient education, not otherwise classified,
nonphysician provider, individual, per session
S9446 Patient education, not otherwise classified,
nonphysician provider, group, per session
S9447 Infant safety (including cardiopulmonary resuscitation)
classes, nonphysician provider, per session
S9451 Exercise classes, nonphysician provider, per session
S9452 Nutrition classes, nonphysician provider, per session
S9454 Stress management classes, nonphysician provider,
per session

37
Commonly Reported ICD-10-CM Codes for
Preventive Services
ICD-10-CM
Code Descriptor Special Coding Conventions
Encounter and Examination Codes
Z00.110 Newborn check under 8 days old Outpatient codes only
Z00.111 Newborn check 8 to 28 days old Outpatient codes only
Z00.121 Routine child health examination with First-listed ICD-10-CM code only.
abnormal findings Includes routine screening when
Z00.129 without abnormal findings performed at same encounter.
Z00.00 General adult medical examination First-listed ICD-10-CM code only.
without abnormal findings Typically used for patients 18 years and
Z00.01 with abnormal findings older (payer policy).
Z02.0 Examination for admission to Not required in addition to a Z00 code
educational institution
Z02.4 Examination for driving license
Z02.5 Examination for participation in sport
Z01.00 Examination of eyes and vision without First-listed ICD-10-CM code only. Do not
abnormal findings report as a secondary code or in addition
Z01.01 with abnormal findings to a Z00 code.
Z01.110 Hearing examination following failed First-listed ICD-10-CM code only. Do not
hearing screening report as a secondary code or in addition
to a Z00 code.
Z01.10 Encounter for examination of ears and First-listed ICD-10-CM code only. Do not
hearing without abnormal findings report as a secondary code or in addition
Z01.118 with other abnormal findings to a Z00 code.
Z23 Immunizations This is the only code in ICD-10-CM for
vaccines. Link to both the product and
administration CPT ® codes.
Z29.3 Encounter for prophylactic fluoride
administration
Screening Codes
Z11.1 Respiratory tuberculosis A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z11.3 Infections with a predominantly sexual A screening code is not necessary
mode of transmission (excludes HPV if the screening is inherent to a routine
and HIV) examination. But can be reported.
Z12.4 Encounter for screening for malignant A screening code is not necessary
neoplasm of cervix (excludes HPV) if the screening is inherent to a routine
examination. But can be reported.
Z12.79 Malignant neoplasm of other genitourinary A screening code is not necessary
organs if the screening is inherent to a routine
Z12.89 Malignant neoplasms of other sites examination. But can be reported.
Z13.29 Other suspected endocrine disorder A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.1 Diabetes mellitus A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
(continued on next page)
38
(continued from previous page)
ICD-10-CM
Code Descriptor Special Coding Conventions
Screening Codes
Z13.228 Other metabolic disorders (eg, inborn A screening code is not necessary
errors of metabolism, galactosemia, if the screening is inherent to a routine
PKU) examination. But can be reported.
Z13.220 Lipid disorders A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.21 Nutritional disorder A screening code is not necessary
Z13.228 Other metabolic disorder if the screening is inherent to a routine
Z13.29 Other suspected endocrine disorder examination. But can be reported.
Z13.0 Diseases of the blood and blood-forming A screening code is not necessary
organs and certain disorders involving if the screening is inherent to a routine
the immune mechanism (eg, anemia, examination. But can be reported.
sickle cell)
Z13.89 Other disorders (eg, depression) A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.4 Developmental disorders in childhood Do not report in addition to a
(excludes routine screening) (eg, autism) Z00.12- code; it is already included.
Z13.88 Disorder due to exposure to A screening code is not necessary
contaminants (eg, lead) if the screening is inherent to a routine
examination. But can be reported.
Performance Measure Codes
Z68.51 Body mass index (BMI) pediatric,
< 5th percentile for age
Z68.52 Body mass index (BMI) pediatric, 5th
percentile to < 85th percentile for age
Z68.53 Body mass index (BMI) pediatric, 85th
percentile to < 95th percentile for age
Z68.54 Body mass index (BMI) pediatric,
≥ 95th percentile for age
Z71.3 Dietary counseling and surveillance
Z71.82 Exercise counseling
Underimmunized Status and Vaccines Not Given
Z28.3 Underimmunized status A status code is informative and may
affect the course of treatment and its
outcome. Report when this is the case.
Z28.01 Vaccine not given: Acute illness
Z28.04 Allergy to vaccine or components
Z28.82 Caregiver refusal
Z28.02 Chronic illness or condition
Z28.03 Immune compromised state
Z28.21 Patient refusal
Z28.81 Pt had disease being vaccinated for
Z28.1 Religious reasons
Z28.89 Other reason
Z28.20 Unspecified reason

39
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busy health professionals. Includes every visit from birth through age 21.

Additional Pediatric Coding Resources

From the American Academy of Pediatrics
New Edition!
Coding for Pediatrics 2018: A Manual for Pediatric
Documentation and Payment
Code it right the first time—and avoid delays and costly denials—with
this widely used pediatric coding resource. Includes all changes in
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for 2018—complete with guidelines for their application.
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For the pediatric provider, coder, and biller, here’s the most helpful
and easy-to-use manual on ICD-10-CM yet. This convenient resource
condenses the vast ICD-10-CM code set into 500 pages of pediatric-
related codes and guidelines.
AAP Pediatric Coding Newsletter™
This unique monthly print and online service brings you timely updates
and expert advice to help you maximize payment, save time, and
implement business practices that help support quality care delivery.
To order these and other pediatric resources, visit shop.aap.org.